Once the terminal diagnosis is known with an elderly client , the care manager is often the one who will initiate and guide advance care planning discussions. As difficult as these discussions may be, the burden on the family is significantly lessened if decisions about advance care planning are made before the client’s condition worsens.
Hopefully this has already been done but many people put it off for fear of death. A recent study found that less than 50% of severely or terminally ill patients had an advance directive in their medical record.
Communication between clients and their loved ones greatly improves the quality of care received as advanced illness progresses. Conversations about quality vs. quantity of life enables care managers to better coordinate services for continuity of care and plan for or stay away from various medical treatments.
The dying person’s decisions about these issues relieve the family from stress and the burden of having to make these decisions. Family members who can participated in end of life discussions about their dying loved ones health care preferences, have the less burden of making treatment decisions . Family members will see out their attending physician as the preferred source of information and reassurance, but the role a geriatric care manager can reducing family burden, by educating the family and avoiding futile life-sustaining therapies if not indicated , and providing effective comfort care.
Advance directives are legal documents that allow clients to make decisions about their health care and finances in advance of when they are not mentally or physically able to do so. These documents which must be signed, dated and witnessed naming another person to make decisions for you.
Your job as a care manager is the make sure the dying client has these documents:
• A durable power of attorney for health care or a health care agent assigned in that document as part of the advanced directive form to make decisions if that person cannot.
• A living will – (This form of advanced directive that only takes effect if you are diagnosed with a terminal illness.)
• A do not resuscitate order DNR (efforts to restart the heart after it has stopped).
• If the client does not have these legal documents pre-hospital admission and wishes to create them, the Geriatric Care Manager will suggest that the documents be put in place with the oversight and consultation of an elder law attorney elder law attorney or the client’s family attorney.